States Make Single-Payer the Standard for Reform


The California legislature is again on the verge of passing universal single-payer health care. SB 840, the California Universal Healthcare Act, sponsored by State Senator Sheila Kuehl, was recently approved by the State Senate and is now before the Assembly, where it too is expected to pass. The legislation, which is often compared to a Medicare-for-all system, would provide comprehensive and seamless health care for all residents. Everyone - individuals, employers and government - would share responsibility for funding the program. Importantly, consumers would have complete freedom to choose their providers who would be paid according to actuarially-sound reimbursement.

As part of the campaign to support the bill, filmmaker Michael Moore premiered his new health care film "SiCKO" at a rally organized by the California Nurses Association in the state capitol of Sacramento. Can Moore do for health care what Al Gore has done for global warming? He's certainly trying to by taking on the uncoordinated, costly, and profit-minded private health care system in his new film.

Cost Savings from Single Payer: Because the California bill lacks a direct funding mechanism, its approval is largely symbolic. However, it reinforces single-payer as the standard against which all health care reform should be measured. Numerous studies and the experience of counties like Canada (see graphic) show that single-payer health care could achieve cost savings and quality standards, let alone health care for all, that our current uncoordinated health care system shows no sign of approaching. According to a financial analysis by the Lewin Group, the California plan, if enacted, would spend $68.9 billion less than the current system by 2015 and achieve $343.6 billion in savings over a 10-year period. Savings would include $20 billion from a mandate that 95% of health care dollars be spent on medical care versus administrative overhead and $5.2 billion in the first year achieved by bulk-purchasing of prescription drugs and medical equipment.

Even though single-payer lacks enough political support to enact it at the state or national level, states, including California and New Mexico, are elevating it as the standard for cost, quality and access.

For instance, the California bill is similar to legislation passed in 2006 that was promptly vetoed by Gov. Schwarzenegger and will be again, but both legislative chambers have passed comprehensive reforms that are now moving into negotiations with Governor Schwarzenegger. SB 840 sets the standard for those negotiations.

New Mexico: The Health Care for New Mexicans Committee, formed by the governor and legislative leaders, has commissioned Mathematica Policy Research to study the state's health care system and evaluate three different approaches to reform: a single-payer system, a voucher approach, and an individual mandate. Since Mathematica has highlighted the cost savings from a single payer approach in analysis of other states, including single-payer as one of three models for study in New Mexico elevates it as a key standard for reform and potentially as a viable option for consideration.

Other states are looking seriously at single payer plans as the gold standard for the cost savings that can be achieved through comprehensive reforms, even if many aren't likely to enact them because of political constraints. If a state won't enact single payer, many advocates are demanding that any alternative proposal at least achieve the same coverage and cost savings.


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